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Catholic health care poised between mission and money

Catholic health care is in the spotlight. The most recent evidence is a front-page article in The Wall Street Journal on Jan. 7 with the headline, “Nuns’ zeal for profits shapes hospital chain, wins Wall Street fans.” Critics are raising questions about the practices of hospitals owned by the Daughters of Charity, cynically nicknamed “Daughters of Currency.”

Specific issues highlighted by the Journal include a $2 billion reserve accumulated by the Daughters of Charity National Health System, a chain of 49 hospitals in 12 states that boasts $6 billion in annual revenue.

“No margin, no mission,” says Sr. Irene Kraus, former president of the Daughters’ system.

The Journal article comes at a time when interest in Catholic health care is already high. Controversy over the sale of St. Louis University Hospital to Tenet Health Care, a for-profit enterprise, has provoked discussion nationally over whether Catholic health care is distinctively different. Officials of the Catholic Health Association have answered with a resounding yes (NCR, Nov. 17).

Yet, it would seem that if such a difference truly existed it would be obvious. The Catholic Health Association has been unable to provide NCR with data showing that care for indigent people at Catholic institutions differs substantially from care offered by non-Catholic, or even for-profit, institutions. The Wall Street Journal cites analysts who note that “key Daughters’ hospitals are located not in inner-city areas but in more affluent suburbs” and others who point out that the amount of net patient revenue that Daughters’ facilities derive from Medicaid is well below the national average -- 6 to 8 percent compared to 14 percent or more.

Institutions like those belonging to the Daughters need not apologize for financial acumen. Three years ago, NCR published a special report on the Catholic health care industry, noting that change and turmoil had forced it to take on all the attributes of a competitive industry and to become as cost conscious and dollar-driven as its secular counterparts.

In today’s environment, hospitals can hardly care for paying patients let alone the poor if they are bleeding red ink. But if Catholics are going to put their names and resources behind health care and promote a healing ministry as rooted in Jesus’ concern for the sick and the poor, then isn’t it reasonable to expect that the care they deliver be distinctively different from that of other public and private institutions? Isn’t it reasonable to expect that the differences would be obvious to all?

Yet in many cases, distinctiveness is blurred. Even if gospel values -- not least of which is a preferential option for the poor -- are driving institutions from within, those values are obscured by the public face of megasystems that rival the largest U.S. for-profit corporations in financial scale.

We can hear predictable voices suggesting that The Wall Street Journal article is just another example of the “secular media” putting the church in a bad light. So it’s worth noting that questions about Catholic health care are also being asked from within.

A radical call for a distinctive witness -- a national health care network to deliver services “in accordance with principles of Catholic social justice” -- came quietly last spring from a distinguished source: Dr. Edmund D. Pellegrino, John Carroll Professor of Medicine and Medical Ethics at Georgetown University and former director of its Center for Clinical Bioethics.

Writing in the March 1997 issue of Christian Bioethics, Pellegrino calls for thorough scrutiny of managed care -- managed care in one form or another being all but synonymous with health care delivery today. He asserts that, while the concept of managed care is “morally neutral,” the current practice is nearly always morally deficient from a Christian point of view.

The most fundamental of a variety of ethical issues driving that assertion: Managed care stands to put cost containment or profit-taking ahead of needs of patients. As antidote, he proposes uniting Catholic hospitals into a single system, a national network that would operate from a gospel vision so attractive, so morally compelling, that its distinctiveness would be unquestioned.

Such a system, however unlikely, could turn formidable financial power into formidable moral power, Pellegrino reasons. Care in such a system would indeed be “managed” --- managed, however, with the focus on making health care accessible to all in society as a fundamental human right rather than on cost containment and the bottom line.

When Catholic officials decried the transfer of a Catholic hospital in St. Louis to a for-profit group, they pointed to an inherent conflict between serving the sick and pleasing investors. Yet, Pellegrino notes, Catholic hospitals, though legally not for profit, are afflicted by similar contradictions. At some point, a quest for margin and huge reserves cripples the mission to serve the indigent and renders moot the debate over how not-for-profit health care is morally superior to for-profit.

Even if “no margin, no mission” were an appropriate slogan, “more margin, more mission” would be morally dubious at best.

If we were given to slogans, we would suggest an alternative to “no margin, no mission.” We would urge leaders of Catholic health care, so given of late to laying up treasures: Seek prophets before profits. Let more voices like Pellegrino’s enter the debate.

At the very least, leaders of Catholic health care should strive to create an environment in which no one, not even the secular media, would dream of calling the Daughters of Charity by any other than their real name.

National Catholic Reporter, January 23, 1998